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From the PRM Pro 4/11/18

April 11, 2018 From the PRM Pro No Comments

Putting the “Value” in Value-based Care
By Jim Higgins

Jim Higgins is the CEO and founder of Solutionreach in Lehi, UT.

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Healthcare in America has struggled with multiple challenges in recent years. Costs are at an unprecedented high while health outcomes are subpar. As of 2017, the cost of healthcare in the US averaged $10,345 per person — the highest healthcare costs in history. And yet, despite spending twice what other developed nations spend for health care, Americans experience a lower life expectancy, greater prevalence of chronic disease, and overall poorer health outcomes. Walter Cronkite once echoed the thoughts of the general public when he said, “America’s health-care system is neither healthy, caring, nor a system.”

In an effort to make care more convenient, effective, and affordable, the healthcare industry has recently been shifting away from volume-based care towards value-based care. This means providers are increasingly receiving payments based on the value of care they deliver rather than the amount of treatment completed. While the push to make this move has been going on for nearly two decades, it’s only recently that the shift has really picked up steam with both government and commercial payers. Experts note that the trend towards value-based care will continue into the foreseeable future. According to a 2016 survey from ORC International, 58 percent of payers are moving towards full value-based reimbursement, and 63 percent of hospitals were part of some ACO. Those numbers continue to grow about 10 percent each year.

What does value-based care mean?

As with any big change, adopting a value-based care model leaves providers with questions. Many of these questions revolve around the meaning of value. How is value defined? What services constitute value? How can a practice determine if they are providing sufficient value? To understand how to implement value-based care, it is critical to know how value is defined. The following are the key initiatives payers use to determine value in a value-based care payment model.

1. Patient experience. At the center of value-based care is the patient experience. Not to be confused with patient satisfaction (which is a subjective measurement), the patient experience encompasses every interaction that can be easily measured. Measurement is key. The patient experience includes things like ease of scheduling, wait times, patient access to healthcare records, and clear communication between the patient and provider. To provide excellent value, every aspect of the patient experience should be as seamless and easy as possible.

2. Proactive care. A major goal of the value-based care model is to improve poor health outcomes through proactive care. Proactive care includes preventative care as well as on-going care for patients with chronic conditions. In days gone by, proactive care often meant simply outlining a health plan and hoping patients adhered to it. Today, practices are expected to implement specific strategies to actually motivate patients to follow those health instructions and show up for regular appointments. Proactive care starts with uncovering the reasons behind non-adherence and then removing those barriers. This often requires more touch points of communication than many practices have historically given. Proactive care strategies can include everything from appointment reminder texts to educational newsletters to video explanations of treatment to medication reminders and more.

3. Patient risk assessment. Using technology, patient data can be analyzed to identify those who have potential health risks. These are the patients most likely to have poor health outcomes and, subsequently, need proactive care. According to a recent Chilmark Research report, current risk stratification models account for only 10 percent of a patient’s health outcomes and are not sufficient to meet the standards of value-based care. These risk models focus on the needs of the practice rather than the needs of the patient. Value-based healthcare organizations should include social, behavioral, and environmental factors in their risk assessments. These social factors account for as much as 70 percent of health outcomes.

4. Care coordination. One “value” pillar that practices should examine is the effectiveness of care coordination across the entire healthcare system. Care coordination, while important for all patients, is especially critical for those patients deemed to be high risk. When care is coordinated across all specialties, practices are better able to eliminate gaps in treatment. Care coordination requires comprehensive and timely communication between all of a patient’s providers and, when done well, leads to improved care and better health outcomes.

5. Patient-reported outcomes. Using a combination of surveys and questionnaires, patients are being asked about their healthcare experiences more than ever. Patient-reported outcomes are defined by the FDA as "any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else." It is through PROs that the more subjective information about a patient’s experience is gathered. Collecting and evaluating this information provides insights that enables practices to develop a more patient-focused (i.e. value-based) process.

The shift to value-based care is often overwhelming at first, but knowing the basics helps ease the transition. The growing pains are worth it. As practices adopt value-based care, the entire healthcare system will benefit — including providers, patients, payers, and society as a whole. Value-based care reduces costs, increases efficiencies, boosts patient satisfaction, and results in better health outcomes. Dedicating the time and training needed to put the “value” in value-based care is a win-win for everyone.


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Jenn, Mr. H, Lorre

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News 4/9/18

April 9, 2018 News No Comments

Top News

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AdvancedMD, Drchrono, Epic Systems, NextGen, NetSmart, Modernizing Medicine, and SIS Amkai score top rankings in Black Book Research’s latest customer satisfaction survey on specialty EHRs.


Webinars

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.

Here’s the recording of last week’s webinar titled “Succeeding in Value-Based Care Via a Technology-Driven Approach,” sponsored by Health Fidelity.


Announcements and Implementations

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Oregon Oncology Specialists will implement Navigating Cancer’s patient relationship management software that includes remote monitoring and patient education, triage, and symptom management tools.

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Triad Radiology Associates (NC) selects billing, coding, and practice management services from Healthcare Administrative Partners.


People

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Tyson McDowell (Lead Wingman) joins blockchain-based PHR startup MintHealth as CTO.

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NueHealth promotes John Palumbo to executive chairman and names Carl King CEO.


Acquisitions, Funding, Business, and Stock

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App-based house call company Remedy secures an early-stage investment from JF2 Capital Partners. Before founding the Texas-based startup, founder Jeremy Gabrysch, MD spent three years as CMO at Soddo Christian Hospital in Ethiopia.

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Radiology practice management and technology company Premier Imaging Ventures rebrands to LucidHealth.

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The New York Times looks at the changing landscape of primary care, highlighting the convenience-based business models of urgent care and retail clinic chains like Healthy Now (WA) and technology-enhanced models of groups like One Medical. While all eyes wait to see what the “mega-mergers” of CVS/Aetna, Amazon/Berkshire Hathaway/JPMorgan, and Walmart/Humana will mean for primary care, hospitals are continuing to encroach on the footprint of independent practices by opening up their own urgent care facilities. “Everyone is fighting for the primary care patient,” concedes Summit Medical Group CEO Jeffrey Le Benger, MD. Summit Medical has also opened up urgent cares, a move Benger refers to as being a “loss leader” for its unprofitability but importance in maintaining patient market share.


Telemedicine

Doctor on Demand leverages Change Healthcare’s Intelligent Healthcare Network to offer patients lab testing facilities based on location and cost.


Other

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A man suffering from shortness of breath credits his visit to a telemedicine kiosk at a local pharmacy for saving his life. (He hadn’t been to the doctor’s in years.) Consulting from nearby New York-Presbyterian Lower Manhattan Hospital, the telemedicine doc advised the patient to check himself into the ER, where he was diagnosed with congestive heart failure, fluid in his lungs, and diabetes. While the availability of a virtual visit was indeed fortuitous, the story is more of a cautionary tale about the dangers of missing regular health checkups.

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The AMA and Google launch the Health Care and Interoperability Innovation Challenge to uncover new ways of monitoring and sharing health data between chronic disease patients and physicians using mobile technology. Up to $50,000 in Google Cloud credits will be awarded to the top three winners.


Sponsor Updates

  • PerfectServe will present at AONE 2018 April 14 in Indianapolis.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 4/4/18

April 4, 2018 News No Comments

Top News

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CCS Oncology’s financial struggles compel it to file for Chapter 11 bankruptcy. Court documents show the New York-based chain of practices will cut its physician workforce from 60 to eight as part of an overall staff downsizing from 181 to 74. The company has also decided to jettison its primary care and non-cancer practices.


Webinars

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April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Enterprises; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

Appriss Health adds HC1.com’s zip code-based Opioid Dashboard to its PDMP technology for government agencies.

C&C Medical Administration launches Web-based coding and billing services.

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Physicians’ Clinic of Iowa will replace its Greenway Health EHR with EClinicalWorks V11.

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Diagnostic Professionals (FL) implements Royal Solutions Group’s Web-based patient intake kiosk and payment software across its four facilities.


Acquisitions, Funding, Business, and Stock

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Optum wraps up its $28 million acquisition of Reliant Medical Group (MA). First announced last May, RMG CEO Tarek Elsawy said the acquisition will enable the physician group to remain competitive, and give it access to advanced data analytics capabilities. Optum won out over Massachusetts-based Harvard Pilgrim and UMass Memorial Health Care, according to state filings.

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Billing, coding, and practice management company AdvantEdge Solutions acquires competitor Professional Management. Former PM President Dave Nicholson will become AdvantEdge EVP.


Government and Politics

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As part of the MyHealthEData Initiative, ONC publishes a consumer-friendly guide to obtaining and using digital health records.


Research and Innovation

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A study in Health Affairs finds a disconnect between EHR quality measurement functionality and the federal programs that link payment to such measures. An analysis of 1,500 practices found challenges with EHR upgrade delays, lack of bandwidth to prepare data for reports (or a lack of resources to outsource preparation), and software that lacked customizable measurements.


Telemedicine

AAFP will offer select members access to virtual care tools from Zipnosis as part of a pilot program before rolling it out to all members later this year.


Other

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The solar-powered town of Babcock Ranch, FL prepares to open a health and wellness center fueled by energy produced during workouts. The center, which also offers physical therapy, will begin offering primary care through Lee Health’s physician group this summer.


Sponsor Updates

  • Aprima will exhibit at the OKMGMA Conference April 5-6 in Oklahoma City.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 4/2/18

April 2, 2018 News No Comments

Top News

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Veritas Capital will acquire GE Healthcare’s Value-Based Care Division – including Centricity, RCM, and workforce management assets – for $1 billion. GE Healthcare President and CEO Kieran Murphy says the business will move forward with a focus on digital precision health solutions that include smart diagnostics, connected devices, AI, and enterprise imaging.


Webinars

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April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

image image

April 10 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

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Cary Skin Center (NC) implements patient referral coordination and communication software from Infina Connect.


People

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Practice Fusion founder and former CEO Ryan Howard (IBeat) joins MTBC as a special advisor to CEO Stephen Snyder. To my knowledge, MTBC is the only ambulatory EHR vendor offering its software to physicians for free, as Practice Fusion did before its Allscripts-influenced move to subscription pricing earlier this year.

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Billing company Inbox Health promotes founder Blake Walker to CEO.

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Payspan promotes Rob Pinataro CEO and appoints Mark Chapman (VoApps) president and CFO.


Government and Politics

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Alabama becomes the 50th state to pass a data breach notification law requiring organizations to notify citizens affected by a breach of electronically stored information within 45 days. California passed the first such law in 2003.


Other

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In JAMA, physicians publish a “Charter on Physician Well-Being,” offering guiding principles and a framework organizations can use to help their physicians avoid burnout.

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Middletown Medical (NY) alerts patients to a January data breach caused by an improper radiology interface security setting that may have allowed users to see patient listings and to access certain PHI.

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Talk about a paper trail: The local paper looks at the efforts the daughter of a local physician who died last spring is going through to return nearly 7,000 paper medical records to their rightful owners. Darcie Maurice-Garcia, who was also her father’s office manager, has gone so far as to take out an ad in the local paper ahead of her self-mandated “Shred Day” on April 4. “I feel like it’s my duty,” she told the Medical Board of California when she reached out for advice on what to do with the files. “I’ve known a lot of these patients all my life.” 


Sponsor Updates

  • HealthcareNow Radio interviews Medicomp Systems CEO Dave Lareau.
  • Nordic publishes a podcast titled “How to use change champions for a more successful go-live.”

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 3/28/18

March 28, 2018 News No Comments

Top News

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An analysis of 7 million patient reviews conducted by MGMA and Healthgrades finds that patients place the most importance on the time their physician spends with them, particularly in the areas of their willingness to answer questions, listen to concerns, and ensure patients understand their conditions or procedures. A practice’s technology offerings didn’t come up in terms of patient satisfaction, though 25 percent of reviews did mention appointment scheduling and communication, leading me to believe that practices that offer time-saving tech in these areas likely receive more positive comments than those that rely on paper-based processes.


Webinars

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April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

image image

April 20 (Tuesday) 3:00 ET. “Using Socioeconomic Data, Not Just Demographics, to Create a Healthier Patient Population.” Sponsor: LexisNexis. Presenters: Erin Benson, director of marketing planning, LexisNexis Health Care; Eric McCulley, director of strategic solutions consultants, LexisNexis Health Care. Did you know that 25 cents of every healthcare dollar is spent on health conditions that are caused by changeable behavior? Use of social determinants of health (SDOH) — including information on households, neighborhoods, relatives, and assets — can directly improve care management and risk stratification. However, it’s important to first define what SDOH is and isn’t. A recent LexisNexis Health Care CIO survey found that only 50 percent of organizations are using SDOH data at all, and even then, they have only limited information from their EHR or from patient surveys. The question is: what are you going to do about it? This webinar will reveal the myths and truths that will help you avoid answering, “Not enough.”

Previous webinars are on our YouTube channel. Contact Lorre for information.


Announcements and Implementations

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Babyscripts adds messaging capabilities for social workers and their patients in a new module aimed at helping expectant mothers in underserved areas stay healthy between OB/GYN visits.

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Healthfinch announces GA of its Refills Lite prescription refill management app for practices using AthenaClinicals.

Chiropractic software vendor EZBIS will integrate Ability Network’s all-payer RCM application into its PM system.

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San Diego-based Reachify launches cloud-based software for physician practices that helps route digital communications from email, social media, and phone to relevant staff members. Co-founders Richard Balikian, MD a plastic surgeon, and Erik Stark, MD an orthopedic surgeon, provided nearly all of the company’s $2 million in early funding.


People

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Patrick Spangler (VigiLanz) and Bryan Archambault (Ghg) join OptimizeRx’s Board of Directors.


Acquisitions, Funding, Business, and Stock

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FBI agents raid several CCS Oncology practices to obtain non-medical information as part of an ongoing investigation related to a late-2017 lawsuit brought by Bank of America against CCS for breach of contract. CCS defaulted on over $16.2 million in debt to the bank. The Williamsville, NY-based chain of practices, which continued to see patients during the federal site visits, has faced financial difficulties since being dropped from Independent Health’s network in 2016.


Government and Politics

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Representative John Nygren (R-WI) credits the state’s 20-percent drop in opioid prescriptions and 47-percent decrease in doctor shopping alerts to the state’s PDMP and tougher prescribing guidelines. Nygren and other members of the state’s opioid abuse task force will next look to integrate a treatment bed tracker with the PDMP – a feature that would be the first of its kind in the nation.


Other

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Soon-to-retire oncologist Mary Ann Allison, MD will miss her patients more than their accompanying paperwork, which typically adds two hours to her day. Allison sees 25 patients in 15-minute increments each day at the Comprehensive Cancer Centers of Southern Nevada – a routine she is looking forward to transitioning away from in favor of gardening and Pilates. “You get to the point where you really kind of want to back off for a bit,” she says. “And things continue to get more complicated, just all this paperwork.”

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DataBreaches.net details the Herculean task it went through to alert a New York-based medical practice with no Web presence that it had left 42,000 patient records and millions of patient clinical notes exposed on a misconfigured rsync backup. Practice staff hung up on the DataBreaches investigator who called to make them aware of the situation, eventually securing the device after an affiliated health system staff member alerted them to the problem. An HHS complaint and request for investigation has since been filed.


Sponsor Updates

  • HealthcareNow Radio interviews Aprima COO Neil Simon.
  • Heather Espino (Centura Health) joins Culbert Healthcare Solutions as Epic manager.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

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